A recent study (A Riskin et al. J Pediatr 2017; 189: 128-34) indicates that routine testing of gastric residual volumes is not needed. In this study of preterm infants ≤34 weeks gestation 239 infants were studied prior and 233 studied after dropping routine checks of gastric residuals.
- Selective evaluation of gastric residuals was associated with achieving full enteral nutrition 1 day earlier
- The rate of NEC (stage ≥2) was actually lower in the selective evaluation group (1.7% vs 3.3%) compared to the historic control group
Selective checking of gastric residuals was prompted by the following:
- abdominal distention
- vomiting or large regurgitation
- bilious regurgitation or emesis
- abnormal behaviors: restlessness, somnolence or apathy
- increased apnea/bradycardia
- change in vital signs
While checking gastric residuals had been used to determine feeding intolerance and/or development of necrotizing enterocolitis, this study indicates that routine evaluation is not necessary.
My take: This study challenged a common NICU practice and found that routine assessment of gastric residuals is not needed; selective checking of gastric residuals is sufficient.